Common Vaginal Infections In Nigerian Women

By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc (Public Health). Medically reviewed by:  C. Wisdom-Asotah, MBBS.
 

Three African women posing together with middle one holding Infection sign.

 

Highlights

• Vaginal candidiasis is a yeast infection affecting up to 75% of women globally. It’s commonly caused by Candida albicans.

• Bacterial vaginosis results from an imbalance of vaginal bacteria. It’s common in low-resource settings and linked to health risks like HIV.

• Trichomoniasis is a parasitic sexually transmitted infection caused by Trichomonas vaginalis.

• Symptoms vary by infection type and may include discharges from the vagina, itching, pain during sex or urination, and abdominal discomfort.

• Treatment options include antifungals for candidiasis and antibiotics for bacterial vaginosis and trichomoniasis.

• Prevention tips include treatment and control of predisposing illnesses, avoiding douching, use of condoms, and limiting sexual partners.

 

 Introduction

“Doctor, I have a ‘toilet infection.’”

This is a common statement that most healthcare practitioners in Africa hear from women who are seen with complaints related to vaginal infections. Women usually attribute any illness associated with discharge and irritation of the vagina to contamination from public toilet use. But is this true?

Vaginal infections result from the colonization of the vagina (the external part of the female reproductive tract) by new organisms or the overgrowth of organisms that commonly live in the vagina.

The common vaginal infections are:

• Vaginal Candidiasis
• Bacterial vaginosis
• Trichomoniasis

Most women would have over-the-counter treatment for some or all of these infections in their lifetime.

Apart from the discomfort associated with them, most vaginal infections do not have life-threatening consequences. However, they may sometimes mimic illnesses that can have long-term effects on the reproductive system, hence the need for proper diagnosis and treatment.

This article will provide information on common vaginal infections and how to treat and prevent them.

 

Common Vaginal Infections in Nigerian Women

The three most common vaginal infections in Nigerian women include:

• Vaginal yeast infection (Candidiasis)
• Bacterial vaginosis
• Trichomoniasis

1. Vaginal yeast infection (Candidiasis)

What is a vaginal yeast infection?

Candidiasis, is also known as vulvovaginal candidiasis or vaginal yeast infection. Globally it affects up to 70–75% of women in their lifetime. In a study conducted in southwestern Nigeria, 40% of the 200 women who were screened had vaginal candidiasis.

It is caused by a type of microorganism (germ) known as fungus. The particular type of fungus that causes candidiasis is the Candida species. [1] Within this type, Candida albicans is the one most commonly associated with Candidiasis (see fig. 1) while other types of Candida cause the disease in about 10% of cases. [1]

 

Fig. 1: Showing culture (left) and microscopic appearance (right) of Candida albicans. Click on image to enlarge.

 

Candida can be found in the mouth, throat, large intestine, and the vagina of women. The organisms usually live in the vagina under normal circumstances. However, under some abnormal circumstances, they may overgrow and lead to symptoms.

Although the organism can be transmitted from one partner to the other during sex, it is not considered a sexually transmitted infection.

2. Bacterial Vaginosis (BV)

What is Bacterial vaginosis?

Bacterial vaginosis affects 23 to 29% of women of reproductive age globally, although it is more common in low-resource settings.

In a study done in North Central Nigeria, 40.1% of the women attending the Gynaecology clinic had Bacterial Vaginosis.

This infection is known to be caused by the overgrowth of some of the bacteria that live in the vagina; particularly Gardnerella vaginalis (see fig. 2).

 

Fig. 2: Showing culture (left) and microscopic appearance (right) of Gardnerella vaginalis. Click on image to enlarge.

 

The vagina is made up of ‘good’ and ‘harmful’ bacteria. Lactobacilli are considered to be good bacteria and they are mostly anaerobic, meaning they thrive in environments with little or no oxygen. [2]

The harmful bacteria are:

•       Gardnerella vaginalis
•        Prevotella spp.
•        Mobilincus species and other organisms

There is usually a perfect balance between the ‘good’ and ‘harmful’ bacteria that live in the vagina. In bacterial vaginosis, an imbalance occurs, leading to the overgrowth of harmful bacteria. What leads to this imbalance is not known.

It is not transmitted through sex, but it may increase the risk of acquiring sexually transmitted infections like the Human Immunodeficiency Virus (HIV)

3. Trichomoniasis

According to the World Health Organization (WHO), there were 156 million new cases of Trichomoniasis infection among people aged 15–49 years in 2020. One-third of these were found in the African region.

In a study conducted in South Eastern Nigeria, 45% of adults attending a clinic were found to have the infection, with women accounting for 63.7% of the cases.

This is caused by the parasite Trichomonas vaginalis. It is the most common reproductive system disease that is not due to a virus. [3] It is considered to be a sexually transmitted infection.

Trichomonas vaginalis is a mobile parasite. This is because it has some projections on its surface (flagellae) that enhance movement (see fig. 3). [4]

 

Fig. 3: Showing culture (left) and microscopic appearance (right) of Trichomonas vaginalis. Click on image to enlarge.

 

This mobility is one reason it increases the transmission of infections like HIV. It lives in the vagina and can also be found in the urinary and genital tract of men, though they are usually without symptoms.

 

Risk Factors for Vaginal Infections 

1. Vaginal Candidiasis

The risk factors for vaginal candidiasis include:

• Vaginal diseases associated with a reduced ability to fight infections, e.g., diabetes, HIV
• Obesity
• Drugs: prolonged use of antibiotics, hormonal medications (estrogen, combined oral contraceptive pills), steroids
• Pregnancy
• Wearing tight, non-absorbent undergarments
• Wet vagina

2. Bacterial Vaginosis

The risk factors for bacterial vaginosis include:

• Douching
• Multiple sexual partners
• Frequent unprotected sex
• Smoking

3. Trichomoniasis

The risk factors for trichomoniasis include:

• Reproductive age group
• Lower socioeconomic status
• Unprotected sexual intercourse (i.e. intercourse without condoms)
• Multiple sexual partners
• Smoking
• Previous history of sexually transmitted infections

 

How to Know If You Have Vaginal Infection

The symptoms of vaginal infections depend on the specific organism. While they may appear similar, there are subtle differences. [1, 2, 3]

1. Symptoms of Candidiasis

You most likely have vaginal candidiasis, if your complaints include:

• Thick, creamy white discharge that looks like milk curds
• Odourless discharge
• Itching in the vagina and vulva
• Burning sensation during urination
• Pain and discomfort during sex
• Swelling of the vulval area
• Excoriations( scratches or skin wounds caused by rubbing, scraping, or picking at the skin

2. Symptoms of Bacterial Vaginosis

You most likely have bacterial vaginosis, if your compliants include:

• Off-white vaginal discharge with a fishy odour
• Itching or irritation of the vagina/vulva
• Painful sex
• Burning sensation during urination

3. Symptoms of Trichomoniasis

You have vaginal trichomoniasis, if your complaints include:

• Thin, yellow-green frothy, foul-smelling discharge
• Itching in the vagina
• Pain during urination
• Pain during sex (dyspareunia)
• Lower abdominal pain (sometimes)

 

What Are the Complications of Vaginal Infections?

1. Complications of Candidiasis

These may be few. However, in some cases, there may be extensive excoriations on the vulva and vagina.

2. Complications of Bacterial Vaginosis

These include:

• Increased risk of sexually transmitted infections (STIs).
• Increased risk of upper reproductive tract infections, including infections of the fallopian tubes and ovaries.
• Higher chances of infection after surgeries involving the abdomen or reproductive tract.
• Pregnancy and post delivery complications such as:
  • Higher risk of miscarriage.
  • Increased risk of infection after a miscarriage.
  • Premature rupture of membranes (early breaking of water).
  • Infection of the placenta and amniotic sac (chorioamnionitis).
  • Preterm labour (delivery before the baby reaches full maturity).
  • Postpartum sepsis (infections in the mother after delivery).
  • Risk of infections in the newborn.

3. Complications of Trichomoniasis

These include: [4]

• Increased risk of sexually transmitted infections (STIs).
• Higher risk of pelvic inflammatory disease (PID) due to untreated infections.
• Infertility as a potential outcome of complications from trichomoniasis.
• Increased risk of cervical cancer, especially in cases with co-infection with Human Papillomavirus (HPV).
• Pregnancy-related complications such as preterm delivery, premature rupture of membranes, and low birth weight.
• Rare newborn infections, where the condition is transmitted to the baby during delivery, potentially causing infections in the vagina or lungs.

 

What to Do If You Have Symptoms of Vaginal Infections

If you experience symptoms of vaginal infections, visit your doctor for a check-up.

This is very important because, while most vaginal infections are mild, some may have harmful long-term consequences. Additionally, vaginal infections can mimic serious upper reproductive tract diseases such as gonorrhoea and chlamydia.

What your doctor will do:

History:

Your doctor will ask questions to find out:

• The type of discharge, including its colour, quantity, and odour.
• Whether you have other symptoms such as itching or swelling.
• Whether you have a fever or pain in your lower abdomen, which may suggest more serious conditions like gonorrhoea or chlamydia.
• The nature of your sexual activity.
• Whether you have other illnesses such as diabetes or HIV.
• Whether you have been on medications like antibiotics or steroids.
• The treatment you may have already received.

Examination:

Your doctor will perform a thorough check on you, which includes:

General Examination

• Assessing your overall state of health.

Abdominal Examination

• Checking your abdomen for signs of pelvic inflammatory disease (PID), which is often caused by gonorrhoea or chlamydia.

Pelvic Examination

• Checking your reproductive pelvic organs via the vagina. These organs include the vulva, vagina, cervix, womb, and the surrounding structures.
• If you have trichomoniasis, the cervix may have a reddish, "strawberry-like" appearance.

Investigations (Tests):

Your doctor may take a swab from your vagina by using a small stick with cotton wool at the tip to collect a sample. This sample will be sent to the lab for study (analysis), which may involve:

• Microscopic examination to identify microorganisms (see figs. 1, 2.and 3).
• Culture tests to determine the specific type of microorganism causing the infection (see figs.1, 2 nd 3).

 

How is Vaginal Infection Treated?

The good news is that all bacterial vaginal infections are treatable and curable. Some of the medications can even be obtained over-the-counter in certain countries. [5]

1. Treatment of Vaginal Candidiasis

Vaginal candidiasis is usually treated with drugs from the imidazole group. The World Health Organization (WHO) recommends the following medications for treatment:

• Fluconazole
• Clotrimazole
• Miconazole
• Econazole
• Nystatin

Fluconazole is administered as oral medication (tablets), while the others are inserted into the vagina.

Special consideration for pregnant women: Only clotrimazole and nystatin are recommended during pregnancy.

Other medications:

• Gentian violet: Applied once weekly to the vagina.
• Boric acid: Inserted as a vaginal tablet once weekly for six weeks.

2. Teatment of Bacterial Vaginosis

The WHO recommends the following medications for adults and young women, including pregnant women:

First-Line treatment:

• Metronidazole (administered in multiple doses).

Alternative options:

If multiple doses of metronidazole are not feasible, other options include:

• Metronidazole gel
• Secnidazole (single dose)
• Tinidazole (single dose)
• Clindamycin tablets (multiple doses)
• Clindamycin gel

3. Treatment of Trichomoniasis

The WHO recommends the following first-line treatments for both pregnant and non-pregnant women:

• Metronidazole (administered in multiple doses or as a single dose).
• Tinidazole (single dose).

Alternative options:

If the first-line medications are unavailable, these drugs are recommended. They include:

• Secnidazole (single dose).
• Ornidazole (single dose).

 

How to Prevent Vaginal Infections

1. Prevention of Vaginal Candidiasis

• Keep the vagina dry by wearing breathable underwear and avoiding wet clothing.
• Avoid using soap in the vagina.
• Avoid unnecessary or prolonged use of antibiotics, hormonal medications and steroids
• Control predisposing conditions such as diabetes.

2. Prevention of Bacterial Vaginosis

• Do not use perfumed soaps, deodorants, or antiseptics in the vagina.
• Avoid douching.
• Avoid smoking.
• Avoid having multiple sexual partners.
• Use condoms properly during sex.
• Consider using probiotics. These are lactobacillus-containing agents given as supplements or inserted into the vagina. However, there is still insufficient scientific evidence to fully support their effectiveness. [6]

3. Prevention of Trichomoniasis

• Avoid douching.
• Use condoms consistently and correctly.
• Avoid having multiple sexual partners.
• Circumcision for the male partner.
• Sexual partner treatment to prevent re-infection.

 

Conclusion

Vaginal infections, though common and often mild, can lead to serious reproductive health complications if left untreated. Early diagnosis, appropriate treatment, and preventive measures are essential for maintaining reproductive health. Women experiencing symptoms should seek professional care to ensure proper management and reduce potential risks.

 

References:

1. Jeanmonod R, Chippa V, Jeanmonod D. Vaginal candidiasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Last updated: Feb, 3, 2024. [Cited 2024 Dec 23]. Available from here.

2. Kairys N, Carlson K, Garg M. Bacterial vaginosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Last updated: May 6, 2024. [Cited 2024 Dec 23]. Available from here.

3. Schumann JA, Plasner S. Trichomoniasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.Last updated:June 12, 2023. [Cited 2024 Dec 29]. Available from here.

4. Van Gerwen OT, Muzny CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Res. 2019 Sep 20;8:F1000 Faculty Rev-1666. doi: 10.12688/f1000research.19972.1. Available from here.

5. Sheppard C. Treatment of vulvovaginitis. Aust Prescr. 2020 Dec;43(6):195–9.Available from here.

6. Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023 May 31;5:1100029. Available from here.

 

Related:

• 13 Ways to Know Why You Are Infertile with Expert Advice on Treatment

• Infertility: Causes in African Women and Men with Prevention Tips

• Infertility in African Women: All You Need to Know

• Social Factors Shaping African Women’s Health

 

Published: February X, 2024

© 2025. Datelinehealth Africa Inc. All rights reserved.    

Permission is given to copy, use and share content for non-commercial purposes without alteration or modification and subject to source attribution.